Basic Information
| Provider Information | |||||||||
| NPI: | 1952785008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OBERG | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1687 WOODLANE DR | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551253046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512098125 | ||||||||
| FaxNumber: | 6513488783 | ||||||||
| Practice Location | |||||||||
| Address1: | 20700 CHIPPENDALE AVE W STE 7 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550248206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513294911 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2015 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 6100 | MN | Y | Chiropractic Providers | Chiropractor |
No ID Information.